Opie, B.O.S, and the Smile Curve

LovingOpie

LovingOpie

Active Member
Here we go again with a new Thread, old link here. . . https://www.felinediabetes.com/FDMB/threads/opie-working-through-wonky.278668/
I shot my first green, was awarded a B.O.S.award and we continue. . . there was the worry that shooting a low number BG would make Opie go low but he never even hit a nadir, just has continued to rise very slowly all night. The numbers are almost identical on each side of the AM nadir making a smile curve but instead of the smile going over the 12 hour cycle he has a long smile going over the 24 hours. I wonder if this is normal.
 
Even though he crossed colours several times it's basically been a flat cycle taking meter variance in to account.

Here's a quote I copied about meter variance from a Marje & Gracie post:

"The 20% variance only applies to tests taken with a single meter. That means if you use Meter A and you take a test and then later take another with Meter A, there is an allowable 20% meter variation. That helps us tell whether the cat is actually flat or going up or down. If the numbers are within 20% of each other, they are, for all intents and purposes, the same number. The 20% meter variation does not apply to human meters of a different type."

A lot of times, it’s not anything to really think about but when you are wondering if the BG is really flat or not, it’s something to consider."
 
Shelley & Jess said:
Even though he crossed colours several times it's basically been a flat cycle taking meter variance in to account.

Here's a quote I copied about meter variance from a Marje & Gracie post:

"The 20% variance only applies to tests taken with a single meter. That means if you use Meter A and you take a test and then later take another with Meter A, there is an allowable 20% meter variation. That helps us tell whether the cat is actually flat or going up or down. If the numbers are within 20% of each other, they are, for all intents and purposes, the same number. The 20% meter variation does not apply to human meters of a different type."

A lot of times, it’s not anything to really think about but when you are wondering if the BG is really flat or not, it’s something to consider."
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thanks for that info! I was calling it a wobble. . .
 
Yay! I see he’s back in blue tonight. I thought so.

To answer your question: It still is a bounce because, for the duration of the bounce, he has the stored form of glucose and counterregulatory hormones working against the insulin — and that makes him temporarily insulin resistant. So his numbers don’t go down like we would expect them to during the cycle. Happily, tonight he’s already back in blue.
 
Suzanne & Darcy said:
Opie really went for it last night. I don’t see anything in the notes about what fed him and when. How did you manage it?
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I did not feed as I wanted to know if he would go below 50 which he might have done before the +4 time. When the numbers came up a bit and at the +6, I fed him 1/2 can of LC FF. I did wonder if we should decrease but opted to see what will happen yet. I could not post or add to the SS overnight as there was a storm and I had no internet. Then my computer froze up until this morning when I got it to go again. This is why I am glad we can text but I am feeling more confident that I know what to do now.
 
Suzanne & Darcy said:
Yay! I see he’s back in blue tonight. I thought so.

To answer your question: It still is a bounce because, for the duration of the bounce, he has the stored form of glucose and counterregulatory hormones working against the insulin — and that makes him temporarily insulin resistant. So his numbers don’t go down like we would expect them to during the cycle. Happily, tonight he’s already back in blue.
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Thanks. This is exactly the kind of information I like, it helps me to understand what he is doing and why. :)
 
After last night I was certain that we would see a long bounce, so I wasn't surprised when we started out in pink. I can't believe it, but he went down to blue at +3. When the numbers go down it is a great thing but a lot of work, when the numbers are high we get to rest. . . the life of a CG.
 
LovingOpie said:
After last night I was certain that we would see a long bounce, so I wasn't surprised when we started out in pink. I can't believe it, but he went down to blue at +3. When the numbers go down it is a great thing but a lot of work, when the numbers are high we get to rest. . . the life of a CG.
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You got it!! Congrats on earning that coveted BOS. You are doing great with him, Julie!!!
 
Well Opie earned a decrease. . . just went down to 30 at +3, fed teaspoon MC Friskies extra gravy 15% and gave Karo. Half hour later he went to 51.
 
Just popped in for a sec, so quick response - Keep a close eye on him please & keep testing every 30 minutes, the quick bump was probably from the Karo, but it'll wear off quick & don't know if MC will be enough to keep him up - you're still really early in the cycle & insulin still working and he could drop again.
 
Shelley & Jess said:
Just popped in for a sec, so quick response - Keep a close eye on him please & keep testing every 30 minutes, the quick bump was probably from the Karo, but it'll wear off quick & don't know if MC will be enough to keep him up - you're still really early in the cycle & insulin still working and he could drop again.
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Yes, I am worried about him going down again, there is a long time til nadir at +6. I also think about the 20% meter fluctuation and wonder if that means he could be that much lower?
Thanks for popping in. . . :bighug:
 
Congrats on the dose reduction!!!

One thing you don’t have is any +2 data. While PZ is not the depot insulins, onset is still about the same and you should be able to get some good info about how the cycle might stack up. On the days he’s not bouncing, he’s well into onset by +3 which tells me he is onsetting around +2. What does that do for you, you ask? If you see him onsetting quickly, you can potentially ward off those steep drops which then result in a bounce. The bigger the drop, the more likely he is to bounce. The goal is to get that BG to come down more steadily and you can do it by checking a little earlier and feeding a little appropriate food to try and flatten the curve a little more. There is a real science to this but also an art since it varies from cat to cat.

If you can change that first test time to +2, then we can see what he’s doing and I can make some other suggestions as to how to help that curve get a little flatter at the beginning.
 
Marje and Gracie said:
Congrats on the dose reduction!!!

One thing you don’t have is any +2 data. While PZ is not the depot insulins, onset is still about the same and you should be able to get some good info about how the cycle might stack up. On the days he’s not bouncing, he’s well into onset by +3 which tells me he is onsetting around +2. What does that do for you, you ask? If you see him onsetting quickly, you can potentially ward off those steep drops which then result in a bounce. The bigger the drop, the more likely he is to bounce. The goal is to get that BG to come down more steadily and you can do it by checking a little earlier and feeding a little appropriate food to try and flatten the curve a little more. There is a real science to this but also an art since it varies from cat to cat.

If you can change that first test time to +2, then we can see what he’s doing and I can make some other suggestions as to how to help that curve get a little flatter at the beginning.
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I will try to get some data for you. I am aware of feeding at that time to slow down the insulin and avoid a steep drop which makes a bounce so I do try to feed him a lot at that time especially. What is a depot insulin and what is depot exactly?
 
What a crazy day. Opie went down to 30 and bounced up to 371 at PMPS. That must be very hard for him. I did lower the dose but I know that it will take a long time for the bounce to clear after today, unless I get very lucky. He does eat well when he is high. Those Pure Bites were a great thing but now he won't eat without topping it and he licks that off and expects more on top. He doesn't actually get down into the real food underneath. I am trying to get him to eat without it now. Yesterday we sat and stared at each other, a bowl of food in front of him. Of course, after a long while who do you think caved in? yep, me
 
You did say he can be very stubborn about food. First thing I did was ask you today about snacks before the 30, after you said he went to 30, and you said he had eaten a whole can of Fancy Feast. So I assume that was at the +2 (or +1)? We have talked a lot about those snacks. But yeah, the +2, if we knew where he was at that time then perhaps you could have given the MC before at +2 to prevent the 30 from happening.
 
LovingOpie said:
I will try to get some data for you. I am aware of feeding at that time to slow down the insulin and avoid a steep drop which makes a bounce so I do try to feed him a lot at that time especially. What is a depot insulin and what is depot exactly?
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I would suggest if you don’t know what the drop is, you can’t feed the correct food in the correct amount. If you look at a bounce clearing cycle, for example, with AMPS of 320 and +2 of 116, that’s a huge drop. Feeding more of a 6% carb food “might” work but it might take more like a 10% carb food. If you don’t know what the +2 is, you might feed a large amount of fairly LC food but it won’t be enough, likely, to slow that train down. If my Gracie was going to clear a bounce, I’d test even at +1 and start slowing her down from there and it might take as much as 13% carbs to get her to flatten out and then come down more slowly.

As an oversimplification. A depot insulin like Lantus or Levemir or their biosimilars (and while they are both depot insulins, the manner in which the depot is formed is different) are slow release and one shot builds upon the previous so you get a cumulative effect over time. PZ is pretty much an “in and out” insulin. If you would like a more detailed explanation, you can read it here.

While PZ is a good insulin, the depot insulins (which are human insulins but work great in cats) are the gold standard. They are not nearly as harsh as insulins like Caninsulin, Vetsulin, Humulin/Normalin. You can get a really nice overlap from one cycle to the next in a really well regulated cat.
 
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After a nice cycle of mostly blue, Opie bounced even higher into red, went only into yellow briefly and is now pink and on his way to red again for PMPS. Ugh . . . at first I thought it was due to feeding him that HC food last night but I see that it is a bounce and a good one. . .
 
I am thinking he may make a move tonight. I think maybe the MC when he was in the 80s last night might have been too much, but you know, it was night time, and I understand. And he did pretty well until the bounce began and you could not stop it. But yes, he could make a move to go lower tonight.
 
Suzanne & Darcy said:
I am thinking he may make a move tonight. I think maybe the MC when he was in the 80s last night might have been too much, but you know, it was night time, and I understand. And he did pretty well until the bounce began and you could not stop it. But yes, he could make a move to go lower tonight.
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You might be right but I doubt real low, though he just hit blue. You will have to explain why it was too much and not right to give MC when I wanted to slow him down from goin under 50. What makes the difference when I am supposed to use MC in the AM to slow down the drop if dropping too fast? I guess I don't understand the fine points of using food.
 
About the food question the other day — the MC question. I don’t think it “wasn’t right” but I was just saying that I don’t think I would have used MC when he was in the 80s because it is overkill. I would have tried spoonsful of LC to see if it would help him surf in green. Of course, if the LC didn’t help him surf then I would have switched to MC as he approached 50. He got a really big spike into blue from the MC so it is easy for me to look back and now say it was overkill, right? It’s my Monday Morning Quarterbacking! At the time you had to make the call and went with MC (it was also night time and your ability to stay up needed to be taken into consideration.) So now we know that Opie gets a really good spike out of MC we can use that information in the future if you really need to bring him up. OBTW, I have named one of the adorable orange kittens that were dumped in Opie’s honor!
 
Suzanne & Darcy said:
About the food question the other day — the MC question. I don’t think it “wasn’t right” but I was just saying that I don’t think I would have used MC when he was in the 80s because it is overkill. I would have tried spoonsful of LC to see if it would help him surf in green. Of course, if the LC didn’t help him surf then I would have switched to MC as he approached 50. He got a really big spike into blue from the MC so it is easy for me to look back and now say it was overkill, right? It’s my Monday Morning Quarterbacking! At the time you had to make the call and went with MC (it was also night time and your ability to stay up needed to be taken into consideration.) So now we know that Opie gets a really good spike out of MC we can use that information in the future if you really need to bring him up. OBTW, I have named one of the adorable orange kittens that were dumped in Opie’s honor!
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Opie will be very honored and an orange one besides! As to food, I think he is super sensitive to carbs so I keep him mostly 5% or less. To me, HC is 14-15% at least that is what I see so far. As for today, he just hit yellow so I am keeping my fingers crossed that he will go down from here and call it an end to the bounce.
 
After 2 cycles of blue yesterday we are again back to pink with a bit of yellow thrown in. Tonight is the 11th cycle with the 1.5 dose. We seem in a holding pattern. It gets rather repetitive doesn't it?
 
LovingOpie said:
After 2 cycles of blue yesterday we are again back to pink with a bit of yellow thrown in. Tonight is the 11th cycle with the 1.5 dose. We seem in a holding pattern. It gets rather repetitive doesn't it?
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I feel your pain right when I get ready to increase Panzer he throws me some greens :arghh: cats!
 
Opie is in a holding pattern, right now third cycle of bouncing. He comes out of a bounce, goes to blue and then bounces again. It just doesn't seem to change. I guess I won't know if this dose is good until he comes out of the bounce long enough to see a real nadir?
 
Hi Julie

What Opie is doing is not uncommon. Many diabetic cats will go up and down around a dose until they finally settle into it and earn a reduction.

He looks to me like he needs a dose increase back to 1.75u but I’d wait and see what he does tonight and if he doesn’t see a nice bit of green (more than just dipping his toes in), I’d suggest raising the dose in the morning.

The other thing you can do when you get him to 1.75u is to not reduce him until you see him go below 40 one time or if you see him go between 40-50 on a few consecutive days. This might indicate he’s about ready for a decrease. Lastly, if you have a cycle where he hasn’t dropped below 40 but you are working hard to keep him from doing so, you will want to decrease the dose back to 1.5u. As we discussed, those +2 tests are important since that is when onset occurs and you can, hopefully, catch the drop before it goes too low. I would even go one step further and if he starts to clear a bounce in a previous cycle and then you get a low bluish number at PS, I’d even test at +1 that cycle.
 
I agree with this. On his current dose he has seen blue nadirs for the most part and I would increase back up to 1.75 and definitely get the really early tests in at +2 (and possibly also the +1 as Marje suggests) in order to head off the lows like the 30 he had at +3 before on 1.75 units. Hopefully increasing the dose back up to 1.75 will allow him to spend more time in lower numbers and get used to them. You can experiment with carbs to see about keeping him from dropping below 50 in order to allow him to spend more time at the 1.75 dose.
 
Marje and Gracie said:
Hi Julie

What Opie is doing is not uncommon. Many diabetic cats will go up and down around a dose until they finally settle into it and earn a reduction.

He looks to me like he needs a dose increase back to 1.75u but I’d wait and see what he does tonight and if he doesn’t see a nice bit of green (more than just dipping his toes in), I’d suggest raising the dose in the morning.

The other thing you can do when you get him to 1.75u is to not reduce him until you see him go below 40 one time or if you see him go between 40-50 on a few consecutive days. This might indicate he’s about ready for a decrease. Lastly, if you have a cycle where he hasn’t dropped below 40 but you are working hard to keep him from doing so, you will want to decrease the dose back to 1.5u. As we discussed, those +2 tests are important since that is when onset occurs and you can, hopefully, catch the drop before it goes too low. I would even go one step further and if he starts to clear a bounce in a previous cycle and then you get a low bluish number at PS, I’d even test at +1 that cycle.
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This is wonderful information. I will definitely do as you suggest.
 
Suzanne & Darcy said:
I agree with this. On his current dose he has seen blue nadirs for the most part and I would increase back up to 1.75 and definitely get the really early tests in at +2 (and possibly also the +1 as Marje suggests) in order to head off the lows like the 30 he had at +3 before on 1.75 units. Hopefully increasing the dose back up to 1.75 will allow him to spend more time in lower numbers and get used to them. You can experiment with carbs to see about keeping him from dropping below 50 in order to allow him to spend more time at the 1.75 dose.
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Thank you. I understand now that the idea is to keep him at as high a dose as works to keep him in the lower numbers for longer periods of time so that his body gets used to it. When the body gets accustomed it is possible to decrease, at least, hopefully.
 
So I increased the dose and tested after the +1 where he was pink, at +3 he went to yellow. I fed him a lot throughout but LC as usual because he was still high. When I tested him at +6 he dropped to 77. This is the time of day when I am not supposed to feed him until PMPS. My question is do I wait until he drops to 50 to give a MC food or do I feed him now since he tends to keep dropping all the way to PMPS? I am guessing that I wait with food and just keep testing. . .
 
I would not feed him yet. Look at June 30. He didn’t keep dropping. And June 21 and June 26. He seems to start going up after +6 on many days (trying to pick out days where we can see a real nadir because he’s not in a bounce.)
 
And I wouldn’t stress too much about the +6 feeding. If you find that is about when he nadirs (and I think he usually does) go ahead with an LC snack at +6. Really it’s still not too late to do an LC snack since, unless I am miscalculating, his +6 was only 25 minutes ago. So you aren’t going to ruin anything. A little LC when they’re in green can help them surf. And the suggestion is not to feed much after nadir so that’s approximately after +6. So it’s a guideline/suggestion and not a hard and fast rule where if you give him a little LC at a little past +6 the whole cycle would be spoiled. You would not spoil anything.
 
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